Aging, Care and Dependency in Multimorbidity: How Relationships Affect Older Bangladeshi Women’s Use of Homecare and Health Services
Bibliographic record
Abstract
Abstract Relationships are multidimensional, and we know little about how different facets of relationships affect how older patients’ with multimorbidity use homecare and health services. Social gerontology literature emphasizes the importance of care settings, gender inequalities, availability of health services, and affordability. However, the diversity of relationships and associated dependency in elder care remains underassessed. This qualitative study combining a demographic survey with interviews explores the relationship experiences of older women (age 60 years and over) with multimorbidity in homecare and health services utilization. Researchers contacted the Civil Surgeon of Sylhet District in Bangladesh to recruit study participants and conducted 33 interviews [11 staff members and 22 older women with multimorbidity]. Three domains of Axel Honneth’s theory of recognition and misrecognition [i.e. intimate, community, and legal relationships] underpin study findings. Data were analysed using critical thematic discourse analysis. Four themes, including seven relationship dimensions, emerged: the nature of caregiving; intimate affairs [marital marginalization and parent-children-in law dynamics]; alienation in peer-relationships and neighbourhood [siblings’ overlooking of women’s rights and needs, neighbourhood challenges such as ageism, and gender inequality in interactions]; and legal connections [ignorance of rights and missed communication]. Marginalization in family relationships, together with poor peer supports and a misrecognition of care needs from service providers, resulted in a lack of quality care for older women with multimorbidity. Understanding the complexities of older women’s relationships may assist in policy making with better attention to their health needs and deepen understanding of how gender inequality intersects with the cultural devaluation of older adults to reduce their well-being. Staff training on relationship building and counselling services for family caregivers and kin are essential to improve the quality of care for these women.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.000 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".